Coding Primary Care
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Coding Primary Care

In blog post "Documenting PQRS", I wrote about how documenting quality care measures on insurance claim forms shows that practitioners of Acupuncture & Oriental Medicine [AOM] can and do contribute to primary care & prevention. Even though we may not get reimbursed, there are E&M in the areas of health behavior, preventive medicine, and counseling:

HEALTH & BEHAVIOR ASSESSMENT, Ea 15 Minutes
  • 96150: Initial
  • 96151:  Re-Assessment
  • 96152:  Individual
  • 96153:  Group (2+ patients)
  • 96154:  Family (w/ patient)
  • 96151:  Family (w/o patient)

 
PREVENTIVE SERVICES
They are not timed based; Illness identified during preventive care are coded separately, but insignificant illnesses not requiring additional work are not reported. There are online widgets that translate ICD9 to ICD10 diagnosis codes.

Initial COMPREHENSIVE PREVENTIVE MEDICINE E&M, W/Hx/Exam, New Patient
  • 99381: Infant < 1 Yr
  • 99382: 1-4 Yr
  • 99383: 5-11 Yr
  • 99385: 12-17 Yr
  • 99386: 18-39 Yr
  • 99386: I40-64 Yr
  • 99387: I65+ Yr

Periodic COMPREHENSIVE PREVENTIVE MEDICINE E&M W/ Hx/ Exam, Established Patient
  • 99391: Infant < 1 Yr
  • 99392: 1-4 Yr
  • 99393: 5-11 Yr
  • 99394:12-17 Yr
  • 99395:18-39 Yr
  • 99396: 40-64 Yr
  • 99397: 65+ Yr

 
COUNSELING CODES
They are time based and used to report activities to prevent illness and promote health (e.g. family dynamics, nutrition, sexual practice, and injury prevention). (Burns, Dunn, Brady, Starr, Blosser, 2013).

PREVENTIVE MEDICINE COUNSELING
  • 99401:  Individual; 15 Min
  • 99302:  Individual; 30 Min
  • 99304:  Individual; 45 Min
  • 99305:  Individual; 60 Min
  • 99411:  Group; 30 Min
  • 99412:  Group; 60 Min

ALCOHOL, SMOKING & TOBACCO Use Cessation Counseling
  • 99406:  intermediate > 3 minutes, up to 10 minutes.
  • 99407:  intensive > 10 minutes
  • 99408: Structured Screening [other than tobacco use]15 to 30 minutes [e.g. AUDIT, DAST, SBI]
  • 99409: Structured Screening [other than tobacco use]  >30 minutes.
  • V65.43: Counseling on substance use and abuse
  • V65.49/ V61.49: Other specified counseling primary/Health problem within family when tobacco cessation counseling is administered to the parent because the child benefits from a reduction in environmental smoke exposure.

OTHER
  • V65.49/ V65.40: Counseling specified/ not otherwise specified
  • V65.3: Dietary surveillance and counseling
  • 1159f: Medication List Documented In Medical Record
  • 99070: Supplies Provided By Physician/Other Professional Over & Above Those Included In The Service.
  • 99071: Patient Education Materials Provided By Physician/Other Professional 


Sources
Burns C., Dunn A., Brady M., Starr N., Blosser C. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.












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